Elder Abuse

Question 1

What is Elder Mistreatment (Abuse and neglect)

Answer 1

Intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. This includes failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.

Question 2

Who is abused more often, Female or male elders?

Answer 2

It appears that female elders are abused at a higher rate than males and that the older one is, the more likely one is to be abused

Question 3

Why are signs of elder abuse sometimes missed by professionals working with older Americans?

Answer 3

• Because they may lack the training needed to detect abuse.
• The elderly may be reluctant to report abuse themselves because of fear of retaliation, lack of physical and/or cognitive ability to report, or because they don’t want to get the abuser (90% of whom are family members) in trouble.

Question 4

An overwhelming number of cases of abuse, neglect, and exploitation go undetected and untreated each year T/F

Answer 4

True

Question 5

Who are the vast majority of abusers?

Answer 5

More than 2/3 of the abusers are family members serving in a care-giving role. Abuse can occur in a person’s own home or in a community living arrangement such as assisted living, personal care homes or nursing homes. A family member, a friend, a caregiver or a stranger can be abusive. The abuser could be someone an older adult relies on or even pays, such as a lawyer, an accountant, a guardian or a nurses’ aide. Some abusers actively seek out people to victimize.

Question 6

People with which disease are at greater risk of elder abuse?

Answer 6

Dementia

Question 7

Types of elder abuse

Answer 7

• Physical abuse
• Mental, emotional, or verbal abuse
• Sexual abuse
• Neglect
• Self Neglect
• Financial Exploitation.

Question 8

What is Georgia’s law on reporting suspected abuse

Answer 8

Georgia law requires mandatory reporting of suspected abuse, neglect or exploitation by certain professionals who are mandated reporters*. Failure for a mandated reporter to report abuse, neglect and/or exploitation of a disabled adult or elder person is punishable by a criminal misdemeanor.

Question 9

True /False- Abuse of older and disabled people is one of the most reported social problems in the U.S.

Answer 9

False it is the most under reported

Question 10

Is elder abuse intentional or unintentional?

Answer 10

Elder abuse is usually intentional. It can involve harming or distressing an older person or not doing something that a person has a duty to do, such as a caregiver not providing medications to an older adult who needs them. Depending on the law an older person is defined as either a person who is 60 or 65 years and older.

Question 11

What are the two most significant problems for caregivers?

Answer 11

Depression and anxiety appear to be significant problems for all caregivers (Tennstedt, 1999). The rate of depression for non-dementia caregivers is 35.2 percent, which is twice that of the general population. Among dementia caregivers, this rate has been found to be as high as 43 – 46%.

Question 12

What % of elder abused case is by a family member?

Answer 12

90% of abuse cases, involves a family member

Question 13

Elder abuse is correlated to race, gender and socio economic status. True / False

Answer 13

False- Little to no correlation w/race, gender, socio-economic status exists

Question 14

True / False- Elders frequently are reticent to report abuse, fearing retaliation, embarrassment, loss of SSI, transfer to NH, etc.

Answer 14

True

Question 15

Signs that someone is the perpetrator of abuse:

Answer 15

• May see regular appts as a threat
• May accompany victim to all appts
• May withhold medication
• May cancel the pt’s appts
• May frequently change health care providers

Question 16

What is Physical Abuse?

Answer 16

Using physical force to coerce or to inflict bodily harm. It often, but not always causes physical discomfort, pain or injury. It may include the willful deprivation of essential services, such as:

• Medical care, food or water.
• Pushing, striking, slapping, pinching, beating
• Burning or scalding
• Hitting with a hand or instrument
• Rough handling
• Improper use of restraints or medications
• Intentional injuries such as bruising, burns, broken bones, or pain
• Injuries that are not consistent with medical diagnosis or explanation
• Forcing someone to remain in a bed or chair
• Forcing someone to remain in a room (including locking them in).

Question 17

What are some signs of physical abuse?

Answer 17

• Sprains, dislocations, fractures, or broken bones
• Burns from cigarettes, appliances, or hot water
• Abrasions on arms, legs, or torso that resemble rope or strap marks
• Internal injuries evidenced by pain, difficulty with normal functioning of organs, and bleeding from body orifices
• Bruises.

Question 18

What are some types of bruises that are rarely accidental:

Answer 18

• Bilateral bruising to the arms (was person shaken, grabbed, or restrained?)
• Bilateral bruising of the inner thighs (may indicate sexual abuse)
• “Wrap around” bruises that encircle an older person’s arms, legs, or torso (was person physically restrained)
• Multicolored bruises (indicating that they were sustained over time)
• Signs of traumatic hair and tooth loss

Question 19

What are some behaviors that could indicate that a elderly patient is being physically abused?

Answer 19

• Injuries are unexplained or explanations are implausible (they do not “fit” with the injuries observed)
• Family members provide different explanations of how injuries were sustained
• A history of similar injuries, and/or numerous or suspicious hospitalizations
• Victims are brought to different medical facilities for treatment to prevent medical practitioners from observing a pattern of abuse
• Delay between onset of injury and seeking medical care

Question 20

What is Emotional/psychological abuse?

Answer 20

The willful infliction of mental or emotional anguish by threat, humiliation, or other verbal or nonverbal conduct.

• Perpetrators may be family members, caregivers, or acquaintances.

Question 21

What are some signs of emotional abuse?

Answer 21

• Significant weight loss or gain that is not attributed to other causes
• Stress-related conditions, including elevated blood pressure

Question 22

What are some behaviors that could indicate that an elderly person is being emotionally abused?

Answer 22

• Has problems sleeping
• Exhibits depression and confusion
• Cowers in the presence of abuser
• Is emotionally upset, agitated, withdrawn, and non responsive
• Exhibits unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking)

Question 23

What is sexual abuse?

Answer 23

Any form of non-consensual physical contact. It includes rape, molestation, or any sexual conduct with a person who lacks the mental capacity to exercise consent.

Perpetrators of sexual abuse include attendants, employees of care facilities, family members (including spouses), and others.

Question 24

What are some signs & Symptoms of Sexual Abuse?

Answer 24

• Genital or anal pain, irritation, or bleeding
• Bruises on external genitalia or inner thighs
• Difficulty walking or sitting
• Torn, stained, or bloody underclothing
• Sexually transmitted diseases

Question 25

What is considered as Financial Abuse?

Answer 25

• Taking money or property
• Forging an older person’s signature
• Getting an older person to sign a deed, will, or power of attorney through deception, coercion, or undue influence
• Using the older person’s property or possessions without permission
• Promising lifelong care in exchange for money or property and not following through on the promise
• Confidence crimes (“cons”) are the use of deception to gain victims’ confidence ;
• Scams (such as telemarketing)

Question 26

Why are the elderly persons made out to be targets?

Answer 26

• Persons over the age of 50 control over 70% of the nation’s wealth
• Many seniors do not realize the value of their assets (particularly homes that have appreciated markedly)
• The elderly are likely to have disabilities that make them dependent on others for help. These “helpers” may have access to homes and assets, and may exercise significant influence over the older person
• They may have predictable patterns (e.g. because older people are likely to receive monthly checks, abusers can predict when an older person will have money on hand or need to go to the bank)
• Severely impaired individuals are also less likely to take action against their abusers as a result of illness or embarrassment
• Abusers may assume that frail victims will not survive long enough to follow through on legal interventions, or that they will not make convincing witnesses

Question 27

What is Neglect?

Answer 27

• The failure of caregivers to fulfill their responsibilities to provide needed care.

Question 28

What is Active Neglect?

Answer 28

Behavior that is willful: the caregiver intentionally withholds care or necessities. The neglect may be motivated by financial gain or reflect interpersonal conflicts

Question 29

What is Passive Neglect?

Answer 29

Situations in which the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity, or lack of resources

Question 30

What are some signs of neglect?

Answer 30

• Poor personal hygiene including soiled clothing, dirty nails and skin, matted or lice infested hair, odors, and the presence of feces or urine
• Unclothed, or improperly clothed for weather
• Decubiti
• Skin rashes
• Dehydration, evidenced by low urinary output, dry fragile skin, dry sore mouth, apathy, lack of energy, and mental confusion
• Untreated medical or mental conditions including infections, soiled bandages, and unattended fractures
• Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes
• Exacerbation of chronic diseases despite a care plan
• Worsening dementia

Question 31

Behaviors associated with Neglect

Answer 31

• Pt exhibits emotional distress such as crying, depression, or despair
• Pt has nightmares or difficulty sleeping
• Sudden loss of appetite that is unrelated to a medical condition
• Confused and disoriented (this may be the result of malnutrition)
• Emotionally numb, withdrawn, or detached
• Exhibits regressive behavior
• Exhibits self-destructive behavior
• Exhibits fear toward the caregiver

Question 32

what is self neglect?

Answer 32

Refers to situations in which there is no perpetrator and neglect is the result of the older person refusing care.

Question 33

Example of Self Neglect

Answer 33

Mrs O lives alone in a 2-story townhouse; she reports that she is 70 years old. She has a bachelor’s degree in education. Twice divorced, she has 1 daughter from whom she has been estranged for many years. Her medical diagnoses include osteoporosis, alcoholism, tobacco use, and recurrent falls. In March 2010, she fell and sustained a hip fracture, necessitating hospitalization for surgical repair. She was discharged to a rehabilitation facility from the acute care hospital, was treated there briefly, then went home. She did not follow up with her family physician as instructed. An anonymous referral was made to adult protective services (APS).

Question 34

Domestic Elder Abuse

Answer 34

Family violence is certain kinds of crimes between people who have a certain kind of connection to each other. The people must be connected to each other as past or present spouses, parents of the same child, parent and child, stepparent and stepchild, or other persons living or formerly living in the same household. The kinds of crimes include battery, assault, stalking, criminal damage to property, unlawful restraint, criminal trespass or any felony.

Question 35

Is family violence a crime under Georgia law?

Answer 35

Yes

Question 36

Who could file a petition for a victim of violence?

Answer 36

Any adult may file a petition for the victim in the superior court for the county where the abuser lives. The petition should ask for a protective order. Petitions may be based on one or more acts of family violence. Within ten days of filing, a hearing will be held to determine whether family violence exists.

Question 37

Some Federal Legislations for the Elderly

Answer 37

Prevention of Elder Abuse, Neglect, and Exploitation (Title VII-A3)

In 1987 AoA established the Prevention of Elder Abuse, Neglect, and Exploitation program. Through the program, AoA provides federal leadership in strengthening elder justice strategic planning and direction for programs, activities, and research related to elder abuse awareness and prevention. This program trains law enforcement officers, health care providers, and other professionals on how to recognize and respond to elder abuse; supports outreach and education campaigns to increase public awareness of elder abuse and how to prevent it; and supports the efforts of state and local elder abuse prevention coalitions and multidisciplinary teams.

AoA allocates grants under this program by formula to states and territories based on their share of the population aged 60 and over.

Question 38

Some Federal Legislations for the Elderly

Answer 38

Elder Justice Act of 2009 was enacted in March 2010 as part of the Patient Protection and Affordable Care Act (H.R. 3590; P.L. 111-148). This Act coordinates federal elder abuse detection and prevention programs within the Office of the Secretary of Health and Human Services. The Act establishes an Elder Abuse Coordinating Council, composed of federal department and agency heads or designees, and an Advisory Board on Elder Abuse, Neglect, and Exploitation, composed of 27 members of the public with expertise in elder abuse prevention, detection, treatment, intervention or prosecution.

Question 39

Legal consequences of elder abuse

Answer 39

• Criminal codes
• Civil remedies
• Probate codes or trusts and estates statutes

Question 40

Failure for a mandated reporter to report abuse, neglect and/or exploitation of a disabled adult or elder person is punishable by a criminal misdemeanor. True / False

Answer 40

True

Question 41

Persons who report elder abuse in good faith are immune from liability. The state law provides parameters for confidentiality of adult protective services records. true /False

Answer 41

True

Question 42

Reasons why people do not report elder abuse

Answer 42

• Only 27% of hospital ERs have protocols for dealing with elder abuse
• Discomfort in confronting the alleged perpetrator
• Fear that the abuser will retaliate against the victim
• Lack of training in recognizing abuse
• Disinclination to be involved in legal system
• Uncertainty about the diagnosis
• Failure to recognize signs/symptoms

Question 43

What are some things a PT could document if they suspect elder abuse?

Answer 43

• Date/time that you saw patient
• Contact information for anyone accompanying the victim
• Patient’s own words
• Detailed description of injuries (location, size, etc.)
• Documentation of any inconsistencies
• Documentation of the clinician’s inquiry (about violence) and the patient’s response
• Photograph (with consent)
• If police were called, the officer’s name, badge no., etc.